Provider Demographics
NPI:1124048541
Name:HENRY COUNTY ORTHOPAEDIC SURGERY & SPORTS MEDICINE,PC
Entity type:Organization
Organization Name:HENRY COUNTY ORTHOPAEDIC SURGERY & SPORTS MEDICINE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-644-2271
Mailing Address - Street 1:1015 KELLEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5819
Mailing Address - Country:US
Mailing Address - Phone:731-644-2271
Mailing Address - Fax:731-644-3980
Practice Address - Street 1:1015 KELLEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5819
Practice Address - Country:US
Practice Address - Phone:731-644-2271
Practice Address - Fax:731-644-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4090498OtherBCBS
TN1205833142OtherGLADWELL NPI
TN1942279807OtherSANDLIN NPI
TN0188163OtherBCBS
TN1346247186OtherMCCABE SMITH NPI
TN4102404OtherBCBS
TN1164429080OtherGULISH NPI
TN200017654OtherPALMETA GBA
TNCG3049OtherPALMETO GBA
TNP00131527OtherPALMETO GBA
TN3903155Medicaid
TN4291627OtherBCBS
TN9002131747OtherPALMETO GBA
TN1124048541OtherGROUP NPI
TN1447574249OtherVIRGINIA PEEBLES, FNP NPI
TN1521937Medicaid
TN3719301Medicaid
TN4058520OtherBCBS
TN4102410OtherBCBS
TN1194018622OtherBARTON NPI
TN1740288349OtherK GULISH NPI
TN4090494OtherBCBS
TN4102122OtherBCBS
TN4288429OtherBCBS
TN4090494OtherBCBS
KY9541Medicare PIN
TN3903155Medicare PIN
TN1164429080OtherGULISH NPI
TN1740288349OtherK GULISH NPI
TN4102404OtherBCBS
TN3719301Medicare ID - Type Unspecified
TN3663101Medicare PIN
TN1194018622OtherBARTON NPI
TN1447574249OtherVIRGINIA PEEBLES, FNP NPI
TN200017654OtherPALMETA GBA